MODIFICATION OF THE PUSH TECHNIQUE FOR PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN INFANTS AND CHILDREN

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) by the ''push'' technique avoids pericatheter infection, repeated insertion of the end oscope, potential esophageal injury from the catheter, and the possibl e need for another endoscopy for catheter removal associated with the ''pull'' technique. In small infants, however, the ''push'' technique could result in loss of gastric insufflation and pneumoperitoneum duri ng tract dilatation. A simple modification of the ''push'' technique h as eliminated this problem. STUDYDESIGN: During a 16-month period, 22 infants and children underwent PEG insertion using our modified ''push '' technique. These cases were reviewed for patient characteristics in cluding age, weight, indication for the procedure, duration of the pro cedure, cost, conversion to open technique, and complications. RESULTS : We have used the modified ''push'' technique to place PEG tubes in 2 0 infants and children aged four weeks to 15 years (mean, 13 months), weighing 2.7 to 36 kg (median, 6.0 kg), indicated for failure to thriv e due to cystic fibrosis (n=3) or neurologic impairment (n=19). These patients have had follow-up examination from nine to 30 months after t he procedure. Operative time averaged 15 minutes. The ''push'' techniq ue was successful in 95 percent of patients with one failure caused by loss of gastric insufflation when Fogarty balloons failed. All PEGs w ere used within 24 hours. There were no deaths and no pericatheter inf ections. CONCLUSIONS: A simple modification of the ''push'' technique of PEG insertion eliminated problems with loss of gastric insufflation previously encountered in small infants. The modified ''push'' techni que is safe, simple, and quick, obviating potential risks inherent in the ''pull'' technique when applied in infants.